Turning the Prevention Spotlight on Ourselves

Sept. 1, 2007
Our formal academic education teaches us to view the world through a preventive lens.

by Anne Nugent Guignon, RDH, MPH

Our formal academic education teaches us to view the world through a preventive lens. We spend precious clinical moments gathering data, determining differential diagnoses, and formatting treatment plans.

The current interest in risk analysis refines our preventive view even further. Most of us routinely apply informal risk analysis in determining a course of action. Many clinicians are embracing advanced diagnostics or using computer-based statistical analysis to sharpen clinical judgment.

In conjunction with our doctors, patients learn their diagnoses and potential or alternative treatment plans, which they either accept or reject. Clinically, we strive to implement appropriate interventions that either prevent or slow down the disease process.

Our outward focus is great for those whom we serve. However, does this point of view, so ingrained in our professional psyche, lead us to unbalanced professional expectations that can lead to emotional or physical burnout?

Burnout is a complex phenomenon that is responsible for the premature demise of many types of professional careers. While manifested as an emotional condition, the origins are often physical.

Many hygienists experience never-ending aches and pains that can be directly traced to how they work in the clinical setting. I meet hygienists all over the country who have had multiple surgeries for workplace-related injuries. Others take massive doses of NSAIDS to make it through the clinical day. Some spend much of their free time and thousands of dollars on massage therapy, chiropractic treatment, and other forms of supportive treatment. Others wear splints. Some have shortened their workdays, and more and more are just walking away from the profession.

A large study of hygienists practicing in Washington State in 2004 found that 78 percent of practicing hygienists had pain or discomfort in the neck, shoulders, arm, wrist, or hand. Ninety-three percent believed the pain was a direct result of their clinical work, and 63 percent had daily pain for more than a week. A smaller study conducted by Kaiser-Permanente in 1993 found 56 percent of those surveyed had shoulder pain and 71 percent had back pain.

These statistics are startling, and my informal polls of audiences all over North America for the past eight years directly parallel these findings. Even more chilling are the number of hygienists who accept pain and discomfort as inevitable and have resigned themselves to the fact that there are no solutions. While pain or discomfort may seem to be an all-too-common occurrence, it is neither normal nor acceptable. There is a silent epidemic in which way too many hygienists and dentists either dismiss or downplay the long-term impact on themselves and their careers. Practicing in pain can suck your emotional reserves dry, lead to a decrease in career satisfaction, or even foster an irreversible injury.

For example, if your hands ache every time you pick up a mouth mirror or put on a pair of gloves, this could simply be indicative of working with improperly fitting gloves, using a tight grasp on an instrument shaft, too much hand scaling, using robust ultrasonic inserts on high power for extended periods, or having dull instruments.

The root issue for hand pain could also be a workplace-related musculoskeletal disorder or a syndrome such as tension neck, thoracic outlet, radial tunnel, carpal tunnel, or lateral epicondylitis. There are dozens of other conditions involving the neck, shoulders, forearms, wrist, and hand that result in aching hands.

Neck pain is another example. Discomfort in this area of the body is nearly always a direct result of poor posture. Clinicians who do not use properly fitted magnification loupes and supplemental illumination are doomed to positioning their head and neck in an unsupported position for extended periods. Eventually Mother Nature will exact a high price for spending hour after hour in pretzel-like postures. In addition, ergonomic chairs with arms help support the entire upper body musculature, which translates to a more comfortable body at the end of the day.

The source of the discomfort may not be the origin of the pain, but identifying the source can help eliminate or even reverse a potentially negative process. Many times, pain or discomfort is a combination of postural discrepancies, poor equipment, improper placement, lack of stretch or rest breaks, or insufficient clinical contact time.

Our dentist-employers are busy running a business and providing needed dental care. If we expect our doctors to be mind readers and anticipate our every need, then the ergonomic process is doomed to failure. It is important to stop accepting discomfort as normal and learn all we can about proper dental hygiene ergonomics. Armed with appropriate information, formulate a personal treatment plan or intervention and present the findings to your employer. Many dentists are simply not aware of the physical toll that clinical practice exacts on our bodies and theirs as well. Remember, this is an educational process for everyone in the practice. Your concern and good information may be well received and result in a safer workplace for you and your colleagues.

If we reorient our thinking process and focus on preventing needless workplace injuries, success can be just around the corner. However, we must be willing to apply the same critical analysis to our professional careers as we do in formulating a preventive plan for our patients.

Are you willing to improve your own clinical comfort zone? It’s time that we get just as worked up about our own physical health and well-being as we do about our patients’ dental and physical health. It is time we quit sacrificing our bodies at the altar of ergonomically distressing therapeutic procedures. It is our responsibility to take ownership of our professional careers. This means organizing our thoughts, learning how to protect ourselves both physically and emotionally, and taking action to create safer working environments.

About the Author

Anne Nugent Guignon, RDH, MPH, is the senior consulting editor for RDH magazine. She is an international speaker who has published numerous articles and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, microultrasonic scaling techniques and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston since 1971. You can reach her at [email protected] or (832) 971-4540, and her Web site is www.anneguignon.com.